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1.
The use of platelet-rich plasma in studies with early knee osteoarthritis versus advanced stages of the disease: a systematic review and meta-analysis of 31 randomized clinical trials
Vilchez-Cavazos F, Blázquez-Saldaña J, Gamboa-Alonso AA, Peña-Martínez VM, Acosta-Olivo CA, Sánchez-García A, Simental-Mendía M
Archives of orthopaedic and trauma surgery. 2022
Abstract
INTRODUCTION Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach to treating knee osteoarthritis (OA). However, the effectiveness of PRP in advanced stages of the disease is not entirely clear. The purpose of this study was to evaluate whether the use of PRP would be as effective in studies with early-moderate knee OA patients compared to studies including patients with end-stage OA, based on the Kellgren-Lawrence classification. MATERIALS AND METHODS A comprehensive search in MEDLINE, EMBASE, Scopus, and Web of Science databases was conducted to identify randomized controlled trials (RCTs) comparing the effect of PRP injections versus other intra-articular treatments on pain and functionality. A meta-analysis was conducted using a random-effects model and the generic inverse variance method. RESULTS We included 31 clinical trials that reported data of 2705 subjects. Meta-analysis revealed an overall significant improvement of both pain [MD, - 1.05 (95% CI - 1.41 to - 0.68); I(2) = 86%; P ≤ 0.00001] and function [SMD, - 1.00 (95% CI - 1.33, to - 0.66); I(2) = 94%; P ≤ 0.00001], favoring PRP. Subanalysis for pain and functional improvement showed a significant pain relief in studies with 1-3 and 1-4 Kellgren-Lawrence OA stages and a significant functional improvement in studies with 1-2, 1-3 and 1-4 knee OA stages, favoring PRP. CONCLUSION Our results indicate that including patients with advanced knee OA does not seem to affect the outcomes of clinical trials in which the effectiveness of the PRP in knee OA is assessed.
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2.
Comparison of the clinical effectiveness of activated and non-activated platelet-rich plasma in the treatment of knee osteoarthritis: a systematic review and meta-analysis
Simental-Mendía M, Ortega-Mata D, Tamez-Mata Y, Olivo CAA, Vilchez-Cavazos F
Clinical rheumatology. 2022
Abstract
INTRODUCTION/OBJECTIVES Platelet-rich plasma (PRP) has shown to be clinically effective in the treatment of knee osteoarthritis (OA). Notwithstanding, some inconsistences remain due to methodological differences in PRP preparation such as the use (or not) of activation strategies. We aimed to evaluate whether the use of non-activated PRP would be as effective as activated PRP in patients with knee OA. METHOD All randomized, placebo-controlled trials were identified through a search in MEDLINE, EMBASE, Scopus, and Web of Science up to June 2022. Pre- and post-injection pain and function scores were collected. The meta-analysis was conducted with a random-effects model and generic inverse variance method. Effect sizes were estimated using standardized mean differences (SMD). RESULTS Fourteen clinical trials involving 1292 subjects were included for meta-analysis. Exogenous activation of PRP revealed a significant pain relief (SMD, - 1.05 [95% CI - 1.58 to - 0.52]; p = 0.0001) and a significant functional improvement (SMD, - 1.21 [95% CI - 1.75 to - 0.67]; p < 0.0001) unlike studies describing the use of a non-activated PRP. The sensitivity analysis indicated that the effect size for both outcomes was not influenced by a single study. CONCLUSIONS The results of this systematic review suggest that the use of an exogenously activated PRP is more effective in improving both pain and functional scores in patients with knee OA. Key Points • Results from meta-analysis suggest that exogenously activated PRP is clinically more effective than non-activated PRP. • The use of an activated PRP was more frequently reported by the included studies. • The most frequent method for activation was the use of calcium chloride (CaCl(2)).
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3.
Tranexamic acid versus aminocapróic acid in multiple doses via the oral route for the reduction of postoperative bleeding in total primary hip arthroplasty: a prospective, randomized, double-blind, controlled study
Morales-Avalos R, Ramos-Morales T, García-Pedro JA, Espinoza-Galindo AM, Acosta-Olivo C, Morcos-Sandino M, Silva-Ramos HNG, Peña-Martínez VM, Rodríguez-Torres RA, Vilchez-Cavazos F
Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 2021
Abstract
To compare the effects of oral ε-aminocaproic acid (EACA) as a hemostatic agent versus the use of oral tranexamic acid (TXA) administered in multiple doses pre and postsurgery in patients undergoing elective primary total hip arthroplasty (THA). We enrolled 102 patients that were randomly divided into two groups: received three oral doses of EACA (2000 mg per dose) or three oral doses of TXA (1300 mg per dose). The medication was given according to the following schedule: 2 h before surgery and 6 and 12 h after surgery. The variables analyzed to compare the effectiveness of the hemostatic agents were total blood loss, hidden blood loss, external blood loss, transfusion rate, intraoperative blood loss, decreases in hemoglobin and hematocrit values, surgical drainage output, visual analog scale, and surgical complications. There were no significant differences between any of the study variables for the group receiving oral TXA and the group receiving oral EACA (P > 0.05). Our study showed that the use of oral EACA was similar to its counterpart TXA regarding the evaluated parameters. TXA did not have superior blood conservation effects, safety profile, or differences in functional scales compared with EACA in THA. We consider the use of multiple oral doses of aminocaproic acid at the selected dose to be effective as a standard protocol to achieve less blood loss and a lower rate of transfusion and adverse events related to the medication in patients undergoing a THA.
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4.
Double-row rotator cuff repair enhanced with platelet-rich therapy reduces re-tear rate: a systematic review and meta-analysis of randomized controlled trials
Villarreal-Villarreal GA, Simental-Mendía M, Garza-Borjón AE, Millán-Alanís JM, Vilchez-Cavazos F, Peña-Martínez VM, Acosta-Olivo CA
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2020
Abstract
PURPOSE To assess re-tear rate in arthroscopic double-row rotator cuff repair (double-row RCR) with and without platelet rich therapy (PRT) METHODS Systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, Embase, and Scopus databases were searched for RCTs involving use of PRT exclusively in arthroscopic double-row RCR. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I(2) statistic index. RESULTS The nine RCT´s included within the meta-analysis demonstrated a risk reduction of 49% for re-tears in patients receiving PRT (risk ratio [RR] 0.51; 95% confidence interval [CI] 0.35 to 0.76; p = 0.0008; I(2) = 0%). Divided by tears sizes, re-tear risk reduction of 47% (RR, 0.53; 95% CI, 0.30 to 0.95; p = 0.03; I(2) = 0%) was found in small-medium tears and of 51% (RR, 0.49; 95% CI, 0.29 to 0.84; p = 0.009; I(2) = 0%) in large/massive tears. Linked double-row RCR resulted in risk reduction of 51% for re-tears in comparison with non-linked repairs. CONCLUSION Double-row RCR plus PRT significantly reduced re-tear rates in all sizes of rotator cuff tears. Linked double-row RCR and applying the PRT during the surgical procedure and in the tendon-bone interface reproduced the best outcomes. Clinically, all patients improved and no statistically significant difference was seen on the clinical and functional scores between both intervention groups. All patients achieved optimal values for PROMs. LEVEL OF EVIDENCE Level I Systematic reviews and meta-analysis of level 1 studies.
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5.
Clinical efficacy of platelet-rich plasma in the treatment of lateral epicondylitis: a systematic review and meta-analysis of randomized placebo-controlled clinical trials
Simental-Mendia M, Vilchez-Cavazos F, Alvarez-Villalobos N, Blazquez-Saldana J, Pena-Martinez V, Villarreal-Villarreal G, Acosta-Olivo C
Clinical rheumatology. 2020
Abstract
To compare the effects of platelet-rich plasma (PRP) injection versus placebo (saline injection) on pain and joint function in lateral epicondylitis in randomized placebo-controlled trials. Randomized controlled trials that evaluated pain (visual analog scale [VAS] and patient-rated tennis elbow evaluation [PRTEE]) and/or functional improvement (PRTEE; disability of the arm, shoulder, and hand [DASH]; and Roles-Maudsley score [RMS]) in patients diagnosed with lateral epicondylitis and compared PRP with placebo injections were considered. The MEDLINE, EMBASE, Web of Science, and Scopus databases were searched from inception to October 2019. The assessment of bias was performed using the Cochrane Risk of Bias Tool version 1. The meta-analysis was conducted with a random effects model and generic inverse variance method. Five trials involving a total of 276 individuals were included. They used a parallel study design and saline solution as placebo. The mean age of participants was 48.0 +/- 9.3 years. Follow-up varied from 2 months to 1 year. No significant changes were noted for pain (standardized mean difference [SMD], - 0.51 [95% confidence interval (CI), - 1.32 to - 0.30]) nor functional scores (SMD, - 0.07 [95% CI, - 0.46 to 0.33]) between PRP and placebo injections. The most frequent adverse reaction reported in two of the five studies was transient post-injection pain for a few days (from 16 to 20% in the PRP group and from 8 to 16% in the placebo group). PRP injection was not superior to placebo for relieving pain and joint functionality in chronic lateral epicondylitis. However, patients reported improvement after both interventions in such clinical parameters. Further randomized trials are required to determine whether PRP injection is clinically more effective than placebo (saline injection).
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6.
Comparison of the Clinical Effectiveness of Single Versus Multiple Injections of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis
Vilchez-Cavazos F, Millan-Alanis JM, Blazquez-Saldana J, Alvarez-Villalobos N, Pena-Martinez VM, Acosta-Olivo CA, Simental-Mendia M
Orthopaedic journal of sports medicine. 2019;7(12):2325967119887116
Abstract
Background: Reports have concluded that platelet-rich plasma (PRP) is an effective and safe biological approach in the treatment of knee osteoarthritis (OA). However, no consensus has been established regarding the number of injections required to observe a therapeutic effect. Purpose: To compare the clinical effectiveness reported in randomized controlled trials (RCTs) of single versus multiple PRP injections in the treatment of knee OA. Study Design: Systematic review; Level of evidence, 1. Methods: A comprehensive search was conducted for RCTs published between 1970 and 2019 that compared the effect of single versus multiple PRP injections on pain and functionality in patients with knee OA. Searched databases included MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. A data extraction form was designed to obtain bibliographic information of the study as well as patient, intervention, comparison, and outcomes of interest data. A random-effects model was used to pool quantitative data from the primary outcomes. Results: We included 5 clinical trials with a low-moderate risk of bias that reported data for 301 patients. Meta-analysis showed that, at 6 months after the intervention, single and multiple (double or triple) injections had similar pain improvement, with no significant differences (standardized mean difference [SMD], 0.61 [95% CI, -1.09 to 2.31]; I (2) = 97%; P = .48). A significant improvement in knee functionality was observed in favor of multiple injections (SMD, 2.29 [95% CI, 0.45-4.12]; I (2) = 97%; P = .01). Subanalysis showed that the significant improvement was only evident for the results of single versus triple injections (SMD, 3.12 [95% CI, 0.64-5.60]; I (2) = 97%; P = .01). Conclusion: According to our results, a single injection was as effective as multiple PRP injections in pain improvement; however, multiple injections seemed more effective in joint functionality than a single injection at 6 months. We consider that the available evidence is still insufficient, and future research on this specific topic is needed to confirm our results.
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7.
Intraarticular injection of platelet-rich plasma in knee osteoarthritis: single versus triple application approach. Pilot study
Simental-Mendia M, Acosta-Olivo CA, Hernandez-Rodriguez AN, Santos-Santos OR, de la Garza-Castro S, Pena-Martinez VM, Vilchez-Cavazos F
Acta reumatologica portuguesa. 2019
Abstract
OBJECTIVE To compare the clinical effectiveness of the triple intra-articular injection of platelet-rich plasma (PRP) with respect to the single injection in patients with mild osteoarthritis of the knee. METHODS A total of 35 patients with a clinical and radiographic diagnosis of osteoarthritis grade I and II were analyzed. They were randomized into two groups: single application (18 patients) and triple application (17 patients). Both groups were evaluated using the Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities (WOMAC) index, and the Health Survey 12v2 (SF-12) at baseline and at 6, 12, 24, 36 and 48 weeks post-treatment. RESULTS Both treatments significantly decreased the level of pain (VAS) (single, from 7.3+/-2.1 to 4.6+/-2.7 and triple, from 6.6+/-2.4 to 0.9+/-1.4; p lt 0.05) and the total WOMAC (single, from 44.2+/-19.7 to 26.7+/-24.9 and triple, from 41.4+/-15.5 to 7.2+/-7.3; p lt 0.05) at the end of the study. The triple application showed better improvement in the VAS (p= 0.0007) and the total WOMAC (p= 0.0209) scores when comparing the final results between groups. CONCLUSION The triple infiltration of PRP in patients with mild knee osteoarthritis is clinically more effective than the single application at 48 weeks of follow-up.
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8.
Treatment of lateral ankle sprain with platelet-rich plasma: A randomized clinical study
Blanco-Rivera J, Elizondo-Rodriguez J, Simental-Mendia M, Vilchez-Cavazos F, Pena-Martinez VM, Acosta-Olivo C
Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. 2019
Abstract
BACKGROUND We aimed to clinically evaluate the effect of platelet-rich plasma (PRP) therapy in patients with acute lateral ankle sprain treated with rigid immobilization. METHODS Patients with first-time grade II lateral ankle sprain clinically diagnosed were evaluated (n=21). A rigid immobilization was placed in all patients for ten days; previously, an application of PRP over the anterior talofibular ligament was performed in patients from the experimental group. The Visual Analogue Scale, the American Orthopedic Foot and Ankle Score, and the Foot and Ankle Disability Index were applied at 3, 5, 8 and 24 weeks of follow-up period. RESULTS The experimental group presented the highest reduction in pain and better functional scores than the control group at 8 weeks. At the end of follow-up period the results of both groups were similar. CONCLUSIONS A similar evolution was observed in patients treated with rigid immobilization with or without PRP after 24 weeks. TRIAL REGISTRATION Clinical Trials.gov with ID NCT02609308.
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9.
First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against epsilon-Aminocaproic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial
Morales-Avalos R, Ramos-Morales T, Espinoza-Galindo AM, Garay-Mendoza D, Pena-Martinez VM, Marfil-Rivera LJ, Garza-Ocanas L, Acosta-Olivo C, Cerda-Barbosa JK, Valdes-Gonzalez NL, et al
The journal of knee surgery. 2019
Abstract
Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versus the use of oral TXA administered in multiple doses pre and postsurgery in patients undergoing total primary knee replacement. We enrolled 92 patients that were randomly divided into two groups: received three doses of aminocaproic acid (2,000 mg per dose) or three doses of oral TXA (1,300 mg per dose). The drugs were administered according to the following schedule: 2 hours before surgery and 6 and 12 hours after surgery. The variables that were analyzed to compare the effectiveness of the hemostatic agents were total blood loss; hidden blood loss; external blood loss; transfusion rate; intraoperative blood loss; decreases in hemoglobin and hematocrit values; surgical drainage output; visual analogue scale; and surgical complications. There were no significant differences between any of the study variables for the group receiving oral aminocaproic acid and the group receiving oral TXA (p > 0.05), with the exception of patients who received TXA, who presented with more adverse events (p = 0.04). Our study showed that the use of oral aminocaproic acid was similar to its counterpart TXA regarding the evaluated parameters. Although patients who received TXA presented an average of 140 mL less blood loss than patients in the epsilon-ACA group, the difference did not appear to be clinically important, the transfusion rate was very low, and there were no between-group differences in postoperative complications.
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10.
Use of ethamsylate to reduce postoperative bleeding and transfusion rate in total hip arthroplasty. controlled clinical trial
Ramos-Sanchez TA, Ramos-Morales T, Morales-Avalos R, Blazquez-Saldana J, Pena-Martinez VM, Vilchez-Cavazos F
Cirugia Y Cirujanos. 2018;86((3)):270-276.
Abstract
Antecedentes: El sangrado secundario es una de las principales causas de morbilidad despues de la cirugia. El etamsilato se ha utilizado con buenos resultados para disminuir el sangrado en diversas patologias, como metrorragias, sangrado intraventricular, prostatectomias, cirugias de catarata y amigdalectomias. El objetivo de este estudio fue evaluar la efectividad del etamsilato para disminuir el sangrado en la cirugia de reemplazo total de cadera. Metodo: La poblacion se dividio en dos grupos. En el grupo control se realizo la hemostasia de manera convencional; en el grupo experimental se administro etamsilato. Resultados: Se incluyeron 34 pacientes, de los cuales 17 fueron aleatorizados al grupo de etamsilato y 17 al grupo control. No hubo diferencias en las caracteristicas de la poblacion entre los dos grupos. Al comparar los valores de hemoglobina preoperatoria y a las 24, 48 y 72 horas posquirurgicas entre ambos grupos, no se encontraron diferencias estadisticamente significativas. Tampoco hubo diferencia en el hematocrito ni en la cuantificacion del gasto por drenaje a las 24 y 48 horas. Hubo tres pacientes transfundidos en el grupo de etamsilato y siete en el grupo de control, lo cual no difirio significativamente (p = 0.62). Conclusion: En este estudio no se demostro un efecto sobre la reduccion de la hemorragia en pacientes sometidos a reemplazo total de cadera con el uso de etamsilato. Background: Secondary bleeding is one of the leading causes of morbidity after the surgery. Ethamsylate has been used with good results to decrease bleeding in various pathologies such as metrorrhagia, intraventricular bleeding, prostatectomies, cataract surgeries and tonsillectomies. The objective of this study was to evaluate the effectiveness of the hemostatic agent ethamsylate to decrease bleeding in total hip replacement surgery. Method: The population were divided into two groups, in the control group was performed the hemostasis conventionally; in the experimental group ethamsylate was administered. Results: A total of 34 patients were included, of whom 17 were randomized to the group of ethamsylate and 17 randomized to the control group. There were no differences in the characteristics of the population between the two groups. Comparing preoperative hemoglobin levels and at 24, 48 and 72 postsurgical hours between the control group and ethamsylate group there was no statistically significant difference. There was also no difference in the levels of hematocrit. In the quantification of expenditure by the drainage there was no difference between the groups at 24 and 48 hours. There were three patients transfused in the ethamsylate group and seven in the control group, which did not differ significantly (p = 0.62). Conclusion: An effect on the reduction of bleeding in patients undergoing total hip replacement with the use of hemostatic agent ethamsylate was not demonstrated in this study.